Information Collection

Contact information form for parents of youth younger than 18 (C.3)

IC 224371 under ICR 201710-0970-007 · OMB 0970-0503.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0503 can be found here:

Documents and Forms

Document Name Document Type
Att_C.3_Contact information form for parents of youth_3-27-17_clean.docx Other-Contact Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Contact information form for parents of youth younger than 18 (C.3)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Contact Form			Att_C.3_Contact information form for parents of youth_3-27-17_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.